- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00645710
Hepatic Arterial Infusion of Floxuridine, Gemcitabine Hydrochloride, and Radiolabeled Monoclonal Antibody Therapy in Treating Liver Metastases in Patients With Metastatic Colorectal Cancer Previously Treated With Surgery
A Phase I/II Trial of Radioimmunotherapy (Y-90 cT84.66), Gemcitabine and Hepatic Arterial Infusion of Fudr for Metastatic Colorectal Carcinoma to the Liver
RATIONALE: Drugs used in chemotherapy, such as floxuridine and gemcitabine hydrochloride, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Hepatic arterial infusion uses a catheter to carry cancer-killing substances directly into the liver. Radiolabeled monoclonal antibodies can find tumor cells and carry tumor-killing substances to them without harming normal cells. Giving hepatic arterial infusion of floxuridine together with gemcitabine hydrochloride and radiolabeled monoclonal antibody therapy after surgery may kill any tumor cells that remain after surgery.
PURPOSE: This phase I/II trial is studying the side effects and best dose of floxuridine when given as a hepatic arterial infusion together with gemcitabine hydrochloride and radiolabeled monoclonal antibody therapy and to see how well it works in treating liver metastases in patients with metastatic colorectal cancer.
Study Overview
Status
Conditions
Intervention / Treatment
- Other: laboratory biomarker analysis
- Other: pharmacological study
- Drug: gemcitabine hydrochloride
- Other: liquid chromatography
- Other: mass spectrometry
- Other: matrix-assisted laser desorption/ionization time of flight mass spectrometry
- Drug: floxuridine
- Genetic: proteomic profiling
- Radiation: yttrium Y 90 anti-CEA monoclonal antibody cT84.66
Detailed Description
OBJECTIVES:
I. To determine the maximum tolerated dose (MTD) and associated toxicities of concurrent hepatic arterial infusion (HAI) fluorodeoxypyrimidine (FUdR)/Decadron and intravenous gemcitabine combined with intravenous yttrium-90 (^90Y) chimeric T84.66 (cT84.66) in colorectal cancer patients after hepatic resection or maximum surgical debulking (to < 3 cm) of liver metastases.
II. To study the feasibility and toxicities of such adjuvant therapy following resection and/or ablation of liver metastases.
III. To evaluate the biodistribution, clearance and metabolism of ^90Y and ^111In (indium-iii) chimeric T84.66 administered intravenously.
IV. To estimate radiation doses to whole body, normal organs, and tumor through serial nuclear imaging.
V. To correlate proteomic profiles pre and post-therapy with toxicities and anti-tumor effects.
OUTLINE: This is a phase I, dose-escalation study of floxuridine followed by a phase II study.
Patients receive floxuridine as a continuous hepatic arterial infusion on days 1-14 and gemcitabine hydrochloride IV over 30 minutes on days 9 and 11. Patients also receive yttrium Y 90 anti-CEA monoclonal antibody cT84.66 IV over 25 minutes on day 9. Treatment repeats every 6 weeks for up to 3 courses in the absence of disease progression or unacceptable toxicity.
Patients may receive an additional course of floxuridine in combination with systemic therapy at the discretion of the treating physician.
After completion of study treatment, patients are followed up at 3 and 6 months.
Study Type
Enrollment (Actual)
Phase
- Phase 2
- Phase 1
Contacts and Locations
Study Locations
-
-
California
-
Duarte, California, United States, 91010
- City of Hope
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion
- Patients must have a Karnofsky performance status of >= 60%; this must be met pre-surgery and pre-study therapy
- Patients must have histological confirmation of colorectal carcinoma and present with potentially resectable or abatable metachronous or synchronous hepatic metastases
- Patients must have colorectal tumors that produce CEA as documented by either immunohistochemistry or by an elevated serum CEA
- Prior radiotherapy, immunotherapy, or chemotherapy must have been completed at least four weeks prior to start of FUdR/RIT therapy on this study (6 weeks if mitomycin-C or nitrosoureas were part of last therapy) and patients must have recovered from all expected side effects of the prior therapy
- Laboratory values must be met pre-surgery and pre-study therapy
- Hemoglobin > 10 gm % (patients may be transfused to reach a hemoglobin > 10 gm %)
- WBC > 4000/ul
- Absolute granulocyte count of > 1,500/mm^3
- Platelets > 150,000/ul
- Patients may have history of prior malignancy for which the patient has been disease-free for five years with the exception of basal or squamous cell skin cancers or carcinoma in situ of the cervix
- Patients must have no prior history of radiation therapy to the liver
- Total bilirubin < 1.5 (unless reversibly obstructed due to the metastatic tumor)
- Serum creatinine of < 2.0
- Patients must have evidence of intrahepatic metastases involving < 60% of the functioning liver
- Patients cannot have evidence of extrahepatic disease with the following exceptions: patients known to have a resectable "anastomotic" or local recurrence of their tumor; patients who undergoing their initial surgery for resection of their primary colorectal carcinoma can have potentially resectable porta hepatis and/or mesenteric lymph node involvement in addition to liver metastases; patients who have disease extension from the liver metastasis that can be resected en bloc (e.g., diaphragm, kidney, and abdominal wall); patients who have minimal, potentially resectable to less than 3 cm extrahepatic disease
- The pre-operative eligibility checklist must be completed
- If a patient has previously received murine or chimeric antibody, then serum anti-antibody testing must be negative (This must be met pre-surgery if possible)
- Serum HIV testing and hepatitis B surface antigen and C antibody testing must be negative
- Women of childbearing potential must have a negative serum pregnancy test prior to entry and while on study must be practicing an effective form of contraception (This must be met pre-surgery and pre-study therapy)
- Patients must have resectable or abatable liver metastases as determined by the attending surgeon
- Colorectal carcinoma must be confined to the liver except as noted above
- Patients with limited extrahepatic disease as defined (primary, lymph node, or anastomotic recurrence) must have disease resected or debulked to less than 3 cm in greatest dimension
- To receive study therapy, patients must be at least 3 weeks post-surgery but no more than 16 weeks post surgery and without evidence of post-operative complications, such as infection or poor wound healing
- Patients must have < 40% liver resected at the close of completion of the hepatic resection
Exclusion
- Patients that have received radiation therapy to greater than 50% of their bone marrow
- Patients with any nonmalignant intercurrent illness (example cardiovascular, pulmonary, or central nervous system disease) which is either poorly controlled with currently available treatment or which is of such severity that the investigators deem it unwise to enter the patient on protocol shall be ineligible
- Biopsy-proven chronic active hepatitis
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Arm I
Patients receive floxuridine as a continuous hepatic arterial infusion on days 1-14 and gemcitabine hydrochloride IV over 30 minutes on days 9 and 11. Patients also receive yttrium Y 90 anti-CEA monoclonal antibody cT84.66 IV over 25 minutes on day 9. Treatment repeats every 6 weeks for up to 3 courses in the absence of disease progression or unacceptable toxicity. Patients may receive an additional course of floxuridine in combination with systemic therapy at the discretion of the treating physician. |
Correlative studies
Correlative studies
Other Names:
Given IV
Other Names:
Correlative studies
Other Names:
Correlative studies
Correlative studies
Other Names:
Given via hepatic arterial infusion
Other Names:
Correlative studies
Given IV
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of Participants With at Least One Dose Limiting Toxicity
Time Frame: 4 weeks from start of treatment, up to 2 years.
|
Dose Limiting Toxicity (DLT) defined as any treatment-related grade grade 3 nonhematologic toxicity not reversible to grade 2 or less within 24 hours, or any grade 4 toxicity.Up to three cycles of therapy were allowed with DLTs determined based on first cycle tolerance.
Toxicity was graded using the National Cancer Institute Common Toxicity Criteria version 2.0.
|
4 weeks from start of treatment, up to 2 years.
|
Recommended Phase II Dose
Time Frame: 4 weeks from start of treatment, up to 2 years.
|
The maximum tolerated dose (MTD) of HAI FUdR in combination with intravenous gemcitabine and 90Y-DTPA-cT84.66 is based on toxicities observed during the first cycle and is defined as the highest dose tested in which fewer than 33% of patients experience an attributable DLT to the study drug, when at least 6 patients are treated at that dose and are evaluable for toxicity.
Dose escalations proceeded according to a standard 3+3 design.
|
4 weeks from start of treatment, up to 2 years.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Overall Survival
Time Frame: Up to 5 years
|
Estimated using the product-limit method of Kaplan and Meier.
Event defined as death due to any cause.
|
Up to 5 years
|
Progression-free Survival
Time Frame: Up to 5 years
|
Estimated using the product-limit method of Kaplan and Meier.
Progression is defined as a 25% increase in the sum of products of measurable lesions over the smallest sum observed, or appearance of any lesions that had disappeared, or appearance of any new lesion/site.
|
Up to 5 years
|
Collaborators and Investigators
Sponsor
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Digestive System Diseases
- Pathologic Processes
- Neoplasms
- Neoplasms by Site
- Disease Attributes
- Gastrointestinal Neoplasms
- Digestive System Neoplasms
- Gastrointestinal Diseases
- Colonic Diseases
- Intestinal Diseases
- Intestinal Neoplasms
- Rectal Diseases
- Neoplastic Processes
- Colorectal Neoplasms
- Neoplasm Metastasis
- Recurrence
- Rectal Neoplasms
- Colonic Neoplasms
- Physiological Effects of Drugs
- Molecular Mechanisms of Pharmacological Action
- Anti-Infective Agents
- Antiviral Agents
- Enzyme Inhibitors
- Antimetabolites, Antineoplastic
- Antimetabolites
- Antineoplastic Agents
- Immunosuppressive Agents
- Immunologic Factors
- Gemcitabine
- Antibodies
- Antibodies, Monoclonal
- Floxuridine
Other Study ID Numbers
- 04122
- NCI-2010-01229
- CDR0000590335 (Registry Identifier: PDQ)
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Liver Metastases
-
Society of Interventional OncologyRecruitingColorectal Liver MetastasesUnited States, Netherlands, Greece
-
Memorial Sloan Kettering Cancer CenterCompletedLocalize Liver MetastasesUnited States
-
Heidelberg UniversityUnknownColorectal Liver MetastasesGermany
-
Dr. M.R. MeijerinkAmsterdam UMC, location VUmcCompletedColorectal Liver Metastases | Metastatic Liver DiseaseNetherlands
-
University of ZurichCompletedColorectal Liver MetastasesSwitzerland, France, Spain
-
Assistance Publique - Hôpitaux de ParisNot yet recruitingUnresectable Colorectal Liver MetastasesFrance
-
Peking University Cancer Hospital & InstituteRecruitingColorectal Liver MetastasesChina
-
Amsterdam UMC, location VUmcCompletedColorectal Liver MetastasesNetherlands
-
David BartlettNational Cancer Institute (NCI); National Institutes of Health (NIH)CompletedColorectal Liver MetastasesUnited States
-
University of MilanCompleted
Clinical Trials on laboratory biomarker analysis
-
Children's Oncology GroupNational Cancer Institute (NCI)Completed
-
Alliance for Clinical Trials in OncologyNational Cancer Institute (NCI)Active, not recruitingLeukemia | Acute Lymphoblastic Leukemia | Acute Promyelocytic LeukemiaUnited States
-
Children's Oncology GroupNational Cancer Institute (NCI)CompletedUntreated Adult Acute Lymphoblastic Leukemia | Untreated Childhood Acute Lymphoblastic LeukemiaUnited States, Canada, Australia, New Zealand, Puerto Rico, Switzerland
-
Children's Oncology GroupNational Cancer Institute (NCI)CompletedChildhood Acute Lymphoblastic Leukemia in Remission | Recurrent Childhood Acute Lymphoblastic LeukemiaUnited States
-
Alliance for Clinical Trials in OncologyNational Cancer Institute (NCI)CompletedLung CancerUnited States
-
Alliance for Clinical Trials in OncologyNational Cancer Institute (NCI)Completed
-
Children's Oncology GroupNational Cancer Institute (NCI)WithdrawnClear Cell Renal Cell Carcinoma | Rhabdoid Tumor of the Kidney | Congenital Mesoblastic Nephroma | Childhood Kidney NeoplasmUnited States
-
Gynecologic Oncology GroupNational Cancer Institute (NCI)WithdrawnBreast Carcinoma | BRCA1 Mutation Carrier | BRCA2 Mutation CarrierUnited States
-
Children's Oncology GroupNational Cancer Institute (NCI)CompletedWilms Tumor and Other Childhood Kidney TumorsUnited States
-
Children's Oncology GroupNational Cancer Institute (NCI)CompletedChildhood Acute Monoblastic Leukemia (M5a) | Childhood Acute Monocytic Leukemia (M5b) | Childhood Acute Myeloblastic Leukemia Without Maturation (M1) | Childhood Acute Myelomonocytic Leukemia (M4) | Childhood Acute Myeloid Leukemia/Other Myeloid MalignanciesUnited States